Should Parents Be Prepped to Leave the Exam Room During Their Teen’s Appointment?

It is relatively common for pediatricians to at some point ask the parent to leave the exam room during a medical visit, usually once the child becomes a teenager. This can be for more private parts of a physical exam and/or discussion of sensitive topics that the child might feel embarrassed to have a parent present.

Recently, Dr. Cora C. Breuner with the Seattle Children’s Hospital spoke at a conference sponsored by the North Pacific Pediatric Society as an expert helping physicians learn to prepare parents to leave the exam room. Pediatric News, and other websites for medical professionals, picked up the story in which Breuner suggests physicians begin preparing parents when their child is between the ages eight and 10. This way, when the time comes years down the road, they won’t resist leaving the room:

She tells parents, “I really need to be your child’s physician, and it’s really important that I have a rapport with him or her. I need the child to trust me, and I need you to trust me,” she said at a conference sponsored by the North Pacific Pediatric Society.

“I need you to trust that I’m going to tell you if there’s a serious medical problem that is uncovered when your child talks with me. I will bring you in on that. Sometimes kids tell me stuff as a provider that they might not necessarily share with you,” said Dr. Breuner, professor of pediatrics and adolescent medicine at the University of Washington, Seattle.

To build a trusted relationship with the patient, Breuner has another line: “Everything you say is between you and me unless you say you hurt yourself or someone else, or someone is hurting you physically or sexually.”

Breuner reportedly uses these lines in every session with patients at these younger ages so everyone is comfortable with what’s to come. Most notably, the more uncomfortable situations in which Breuner and other pediatricians have to mitigate in the parent-patient-physician relationship are those of a sexual nature.

Breuner cites an example of a 14-year-old who was sexually active and wanted to receive birth control without her parents knowing. Birth control would of course show up as a medical expense. Here are the options Breuner would suggest giving the teen while they’re alone at the appointment:

First she helps the patient calm down emotionally and step back from the flood of feelings, then she gives her three options: She can go down the street to Planned Parenthood for contraception and screenings without being billed. “Or, I can bring your mom and dad in, one at a time or together, and have a conversation as your advocate, because I’m your provider. Or, you can stop having sex. It’s your call, but you need one of those three things to happen,” Dr. Breuner said.

Patients typically worry that their parents will get mad or upset.

“You have to trust me on that,” Dr. Breuner said. “I’m pretty good at doing this, I think, and can advocate for you to keep you safe. Or, you can have a really terrible car ride home” if the parents aren’t let in. “Maybe I can help you.”

The law on parent’s rights regarding their minor’s medical privacy varies by state, but overall the Health Insurance Portability and Accountability Act (HIPPA) allows parents to access medical records of their minors with these exceptions:

When the minor is the one who consents to care and the consent of the parent is not required under State or other applicable law;

When the minor obtains care at the direction of a court or a person appointed by the court; and

When, and to the extent that, the parent agrees that the minor and the health care provider may have a confidential relationship.

There are some who believe that laws at the federal level and practices within the medical profession are stripping parents of their rights over their children. ParentalRights.org is one such group that believes HIPPA and the Family Educational Right to Privacy Act (FERPA) are examples of laws that were “intended for good, to enact privacy regulations preventing third parties from accessing educational or medical records” but were left with ample room for interpretation that can “shut parents out of their children’s lives by denying them access to important information about their children.”

What do you think of parent’s being prepped to leave the exam room? Share your thoughts in the comments section below.

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